Coming Off Psychiatric Drugs

Withdrawal symptoms 

As all psychiatric drugs change brain and body chemistry, they may all cause withdrawal symptoms, especially if you have been taking them for a long time. You will not necessarily get any withdrawal symptoms when coming off, but many people do. The symptoms differ to some extent between drug types. 

Information on the withdrawal effects of different types of drugs is given in the following sections below: 

Antidepressants 

Antipsychotics 

Lithium and other mood stabilisers 

Sleeping pills and minor tranquillisers. 

How can I tell whether I have withdrawal symptoms or my mental health problem is coming back?

Symptoms caused by drug withdrawal	Symptoms caused by relapse
usually happen very soon after you start to come off. This is related to half-life – in a drug with a long half-life, withdrawal effects will be delayed by as much as two weeks.	are delayed, and are not related to the half-life of the drug
are often different from anything you have had before	are the same as the symptoms you had before – when you first started the drug
go as soon as you re-start the drug	get better slowly if you re-start the drug
will eventually subside without treatment if you don’t re-start the drug	continue indefinitely without other treatment

Switching drugs to help withdrawal

If you are taking a drug with a short half-life and having problems with withdrawal symptoms, it may be possible for you to switch to a related drug with a long half-life, which should be easier to come off. You will need the help of a doctor to switch drugs because your prescription will need to be changed. 

Tranquillisers and sleeping pills

The benzodiazepine tranquilliser with the longest half-life is diazepam (Valium/Stesolid/Valpam). If you are coming off one with a short half-life you could switch to diazepam. 

Some people also use diazepam to help come off the ‘z’ sleeping pills, which act in a very similar way to benzodiazepines. 

Equivalent doses for benzodiazepines and ‘z’ sleeping pills

Change to 5mg of diazepam (Valium/Stesolid/Valpam) from:   chlordiazepoxide 15mg   lorazepam 500mcg (0.5mg)   lormetazepam 0.5–1.0mg   nitrazepam 5mg   zolpidem 10mg   zopiclone 7.5mg

Antidepressants

The SSRI antidepressant with the longest half-life is fluoxetine (Prozac). It may be helpful to switch from a drug with a short half-life (such as paroxetine) to fluoxetine and slowly withdraw from that. As fluoxetine takes a little while to build up in your system, some specialists suggest starting it while you lower the dose of the other drug, taking both drugs together for a week or two.

Equivalent doses for SSRI antidepressants and venlafaxine

Change to 20mg fluoxetine liquid from:   citalopram 20mg   escitalopram 10mg   fluvoxamine 50mg   paroxetine 20mg   sertraline 50mg   venlafaxine 75mg

When coming off antidepressants, an alternative to fluoxetine is to switch to clomipramine 100mg/day. 

Antipsychotics

Drug switching techniques may be used with antipsychotics but you would need advice from a psychiatric pharmacist or psychiatrist on which drug to switch to. 

Lithium and other mood stabilisers

You would need advice from an experienced psychiatrist or psychiatric pharmacist on whether this technique would work for mood stabilisers, and which drugs might be suitable to switch to. 

It’s possible that you might be advised to switch to antipsychotic medication.